Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204E00000X | Oral & Maxillofacial Surgeon | 6087 | MD |
NPI | 1114015088 |
---|---|
Provider Name | Dr. Bennett Frank Frankel |
First Address | Prince Frederick, MD 20678 |
Second Address | Prince Frederick, MD 20678 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/10/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
97970001 | BCBS NCA (01) | DC |
R180BF | BCBS MD (01) | MD |
T59655 | (02) |